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DOI: 10.1055/s-2005-861944
Neurological outcome of hemiarch vs. total arch replacement for acute type A dissection
Objectives: To evaluate the impact of selective antegrade cerebral perfusion (SACP) and moderate hypothermic circulatory arrest (HCA) on mortality and neurological outcome after proximal or total arch replacement in patients with acute aortic type A dissection.
Material and Methods: Fifty-two patients underwent replacement of the proximal (group A, n=35) or the total aortic arch (group B, n=17) using HCA with SACP. Mean age was 59±13 years and did not differ between groups. Preoperative hemodynamic instability was present in 34% (12/35) in group A and 29% (5/17) in group B (p=ns). New preoperative neurological symptoms were found in 23% (8/35) in group A and 24% (4/17) in group B (p=ns). Valve sparing root replacement has been performed in 43% (15/35) in group A and 47% (8/17) in group B (p=ns).
Results: In hospital mortality was significantly higher in group B [14.3% (5/35) vs. 35% (6/17); p=0.02]. In both groups, heart failure and significant bleeding complications were the main reasons for in-hospital deaths. Permanent neurological dysfunction occurred 13.3% (4/30) in group A and 18.1% (2/11) in group B (p=ns). Temporary neurological dysfunction was detectable in 17.1% (6/35) in group A and 12% (2/17) in group B (p=ns).
Conclusions: SACP allows to perform total arch replacement with no increased risk of new neurological dysfunction in acute aortic type A dissection. However, total arch replacement was accompanied by a significantly higher mortality. Limited arch replacement (proximal arch) showed a favourable mortality rate in acute type A aortic dissection.